Remote Medicaid Program Integrity Director

UnitedHealth Group; Eden Prairie (MN); Hybrid; Confidential; Full time

Benefits offered by this job

Equity stock purchase

401k contribution

Comprehensive benefits

Job summary

UnitedHealth Group seeks a senior Medicaid Program Integrity Leader to develop and oversee strategies ensuring compliance with CMS and state regulations while preventing, detecting, and addressing fraud, waste, and abuse across Medicaid programs.

The role balances regulatory compliance, financial stewardship, and stakeholder engagement, leading cross-functional teams and collaborating with internal and external partners.

Qualifications

• 5+ years in healthcare, Medicaid, compliance, audit, investigations, or program integrity.
• 5+ years of leadership experience managing teams and complex programs.
• 5+ years of experience with fraud, waste, and abuse investigations and audit programs.
• 2+ years of experience with Medicaid managed care regulations, CMS guidance, and program integrity requirements.
• 2+ years of experience in data analytics and reporting capabilities.
• Excellent communication, executive presentation, and stakeholder management skills.
• Ability to travel up to 25%.

Responsibilities

• Develop and execute the organization's Medicaid Program Integrity strategy.
• Establish goals, KPIs, and performance metrics aligned with organizational objectives.
• Lead program integrity operations across pre-payment, post-payment, and support development of new business operations.
• Oversee audits, investigations, and regulatory reviews.
• Present findings, risks, and recommendations to executive leadership.

Skills

Leadership

Communication

Stakeholder management

Travel willingness

Job description

UnitedHealth Group seeks a senior Medicaid Program Integrity Leader to develop and oversee strategies ensuring compliance with CMS and state regulations while preventing, detecting, and addressing fraud, waste, and abuse across Medicaid programs.

The role balances regulatory compliance, financial stewardship, and stakeholder engagement, leading cross-functional teams and collaborating with internal and external partners.